Instruments Set for Gamma Nails – 50-Piece Cephalomedullary Trochanteric Nail Fixation Instrumentation

<p>The Instruments Set for Gamma Nails from Peak Surgicals (SKU: PS-OP-708, PS-1000 series) is a 50-piece cephalomedullary Gamma nail instrumentation set in stainless steel, designed for the complete intraoperative workflow of Gamma nail fixation of trochanteric and subtrochanteric femoral fractures — covering proximal femoral entry portal preparation with a Cannulated Awl (PS-1000.09), proximal trochanteric canal reaming with five Reamer Shafts with Fixed Reamers Ø9–13mm (PS-1000.09 to PS-1000.13) and a Reamer 17mm (PS-1000.23), guide wire management with a Guide Rod (PS-1000.49) and Reaming Rod (PS-1000.50) and three Threaded Guide Pins (PS-1000.32), proximal lag screw targeting with a Proximal Targeting Device with Screw (PS-1000.01), distal locking with a complete mechanically guided Distal Targeting System including Distal Targeting Device with Screw (PS-1000.02), Distal Guide Bar ×2 (PS-1000.03, PS-1000.29), Targeting Bar (PS-1000.07), Sliding Mass for Targeting Bar (PS-1000.08), Distal Targeting Device (PS-1000.06), and Distal Guide Bar Connector (PS-1000.28), distal locking screws preparation with Drill Sleeve OD 9.5mm (PS-1000.37), Step Drill & Drill Stop (PS-1000.34), Drill Bits 5mm ×2 (PS-1000.45), Drill Bit 6mm (PS-1000.44), Drill Bit (PS-1000.43), T-Type Drill Bit 5.84mm (PS-1000.39), Protection Sleeves (PS-1000.11, PS-1000.26, PS-1000.46), Drill Sleeves (PS-1000.12, PS-1000.47), Trocars ×2 (PS-1000.13, PS-1000.48), Depth Gauge (PS-1000.40), nail insertion with Nail Handle (PS-1000.04), Connection Screws ×2 (PS-1000.05), Fixture Block (PS-1000.14), Sliding Hammer (PS-1000.15), Hammer (PS-1000.10), Soft Tissue Separator Short (PS-1000.16), Soft Tissue Protector (PS-1000.26), and Alignment Rod (PS-1000.36), screw insertion and locking with T-Wrench for Gamma Nail Lag Screw and Coupling Screw (PS-1000.17), Hex Screwdrivers 3.5mm (PS-1000.18), 4.0mm (PS-1000.19), and 5.0mm (PS-1000.20), Locking Nut Wrench (PS-1000.21), Polyaxial Hex Wrench (PS-1000.24), L-Key 5mm (PS-1000.27), Locking Nut Long (PS-1000.30), Locking Nuts Short ×2 (PS-1000.31), nail extraction with a Nail Extractor (PS-1000.35), instrument maintenance with two Cleaning Guide Pins (PS-1000.22, PS-1000.42) and Quick Coupling T-Handle with Chuck and Key (PS-1000.25), and a Medullary Tube (PS-1000.41), all in an Empty Container (PS-1000.090). It is used by orthopedic and trauma surgeons performing Gamma nail cephalomedullary fixation of trochanteric, intertrochanteric, and subtrochanteric femoral fractures.</p>

<h2>The Gamma Nail: Cephalomedullary Design for Trochanteric and Subtrochanteric Fractures</h2>
<p>The Gamma nail is a cephalomedullary intramedullary nail that enters the proximal femoral medullary canal at or near the tip of the greater trochanter and extends distally along the femoral shaft, while accepting a single large-diameter lag screw directed proximally and laterally from the nail's proximal lag screw hole into the femoral head and neck — the Gamma nail's characteristic proximal lag screw is larger in diameter and has a more direct trajectory than the two-screw or blade designs used in other cephalomedullary nails. The original Gamma nail design, developed by Grosse and Kempf, uses a single large lag screw that provides robust femoral head fixation with resistance to both rotation and varus collapse from a single implant in the femoral head. The Gamma nail's trochanteric entry and the angle between its intramedullary shaft and the proximal lag screw hole are specifically designed for the geometry of the trochanteric region — the nail enters at the greater trochanter apex rather than requiring the piriformis fossa entry of original straight nails, making the trochanteric approach faster and reducing the risk of abductor damage compared to piriformis fossa entry. The PS-1000 Instruments Set for Gamma Nails provides the complete instrument set for the entry portal, proximal canal reaming, lag screw targeting, nail insertion, lag screw insertion, distal locking, and nail extraction steps of the Gamma nail procedure.</p>

<h2>Proximal Femoral Entry and Canal Preparation: Cannulated Awl, Reamers, Guide Rods</h2>
<p>The Cannulated Awl (PS-1000.09) creates the initial trochanteric entry portal at the tip of the greater trochanter under fluoroscopic guidance — the awl penetrates the cancellous bone of the trochanteric tip and enters the proximal femoral medullary canal at the correct entry point for the Gamma nail's straight trochanteric trajectory. The Reaming Rod (PS-1000.50) and Guide Rod (PS-1000.49) provide the guide wire infrastructure for progressive reaming over the guide wire from the entry portal to the distal femoral canal. The Medullary Tube (PS-1000.41) provides an additional guide channel for the reaming sequence. The five Reamer Shafts with Fixed Reamers (PS-1000.09 to PS-1000.13: Ø9, 10, 11, 12, 13mm) sequentially ream the proximal femoral canal from the entry portal to the isthmus level, and the Reamer 17mm (PS-1000.23) prepares the wider proximal trochanteric portion of the canal to accept the larger proximal diameter of the Gamma nail — the proximal flare of the Gamma nail is typically 15–17mm and requires the 17mm reamer to create the correct proximal entry channel for smooth nail introduction without proximal cortex impaction. The Alignment Rod (PS-1000.36) confirms the rotational alignment of the nail during insertion. The Soft Tissue Separator Short (PS-1000.16) and Soft Tissue Protector (PS-1000.26) protect the soft tissue of the proximal thigh during the portal and reaming steps.</p>

<h2>Proximal Targeting and Lag Screw System</h2>
<p>After the Gamma nail is inserted to the correct depth and confirmed fluoroscopically, the proximal targeting assembly is attached to guide the lag screw into the femoral head. The Proximal Targeting Device with Screw (PS-1000.01) attaches to the Nail Handle (PS-1000.04) and directs the lag screw guide wire trajectory at the nail's fixed neck-shaft angle (typically 130° or 125° depending on the Gamma nail model) into the inferior-posterior quadrant of the femoral head at the correct tip-apex distance. The three Threaded Guide Pins (PS-1000.32) are placed through the targeting device into the femoral neck and head at the planned lag screw trajectory, and the correct guide pin position is confirmed on biplane fluoroscopy before drilling begins. The T-Type Drill Bit 5.84mm (PS-1000.39) drills the lateral cortex channel for the lag screw barrel. The Hex Screwdrivers — 3.5mm (PS-1000.18), 4.0mm (PS-1000.19), and 5.0mm (PS-1000.20) tip — drive the respective locking elements. The T-Wrench for Gamma Nail Lag Screw and Coupling Screw (PS-1000.17) applies the final assembly torque to the lag screw and the coupling screw that locks the lag screw's rotation and sliding mechanism. The Locking Nut Wrench (PS-1000.21) tightens the locking nut. The Polyaxial Hex Wrench (PS-1000.24) and L-Key 5mm (PS-1000.27) manage the remaining locking elements. The Locking Nut Long (PS-1000.30) and Locking Nuts Short ×2 (PS-1000.31) are the specific nut configurations for the lag screw and coupling screw assemblies.</p>

<h2>Distal Locking System and Nail Extraction</h2>
<p>Distal locking of the Gamma nail prevents rotation and shortening at the fracture site. The mechanically guided distal targeting system consists of the Distal Targeting Device with Screw (PS-1000.02), Distal Guide Bar ×2 (PS-1000.03, PS-1000.29), Distal Guide Bar Connector (PS-1000.28), Distal Targeting Device (PS-1000.06), Targeting Bar (PS-1000.07), and Sliding Mass for Targeting Bar (PS-1000.08) — these components connect to the Nail Handle to provide the mechanical targeting reference for the distal nail locking hole positions. The targeting assembly guides the Protection Sleeves (PS-1000.11, PS-1000.46) and Drill Sleeves (PS-1000.12, PS-1000.47) to the correct locking hole positions in the distal nail through the thigh soft tissue. The Drill Sleeve OD 9.5mm / ID 8.33mm (PS-1000.37) and Drill Sleeve Fixture Rod (PS-1000.38) provide the drill guidance at the locking hole level. The Trocars (PS-1000.13, PS-1000.48) and Fixture Block (PS-1000.14) provide the trocar access and positioning for the locking approach. The Drill Bits — 5mm ×2 (PS-1000.45), 6mm ×1 (PS-1000.44), and general (PS-1000.43) — drill the cortical entry for the distal locking screws. The Depth Gauge (PS-1000.40) measures drill depth for locking screw length selection. The Step Drill & Drill Stop (PS-1000.34) provides a stepped drill with integral depth stop for the distal cortical entry. The Sliding Hammer (PS-1000.15) and Hammer (PS-1000.10) drive the nail to final position and provide impaction force during nail insertion. The Nail Extractor (PS-1000.35) removes the Gamma nail at revision surgery or if intraoperative nail repositioning is required.</p>

<h2>CE Mark, ISO 13485, and FDA Certification for Gamma Nail Instrumentation Procurement</h2>
<p>The Instruments Set for Gamma Nails is manufactured under CE Mark, ISO 13485, and FDA compliant quality standards. ISO 13485 certification confirms Peak Surgicals operates a documented quality management system covering design control, material traceability, and production consistency for orthopedic surgical instruments. CE Mark confirms conformity with European medical device regulations, and FDA compliance supports procurement for US-based hospitals, trauma centers, and orthopedic departments requiring verified regulatory documentation for cephalomedullary Gamma nail instrumentation purchases.</p>

<h2>Product Specifications</h2>
<table>
  <tbody>
    <tr><th>SKU</th><td>PS-OP-708</td></tr>
    <tr><th>Product Name</th><td>Instruments Set for Gamma Nails</td></tr>
    <tr><th>Price</th><td>$1,376.06 USD</td></tr>
    <tr><th>Instrument Series</th><td>PS-1000</td></tr>
    <tr><th>Total Instruments</th><td>50 + Empty Container (PS-1000.090)</td></tr>
    <tr><th>Instrument Category</th><td>Orthopedic — Cephalomedullary Gamma Nail Fixation</td></tr>
    <tr><th>Procedure</th><td>Gamma nail fixation of trochanteric, intertrochanteric, and subtrochanteric femoral fractures</td></tr>
    <tr><th>Entry Portal</th><td>Cannulated Awl (PS-1000.09), Guide Rod (PS-1000.49), Reaming Rod (PS-1000.50), Medullary Tube (PS-1000.41)</td></tr>
    <tr><th>Reamers</th><td>Reamer Shafts with Fixed Reamers Ø9/10/11/12/13mm ×5 (PS-1000.09–13), Reamer 17mm (PS-1000.23)</td></tr>
    <tr><th>Proximal Targeting</th><td>Proximal Targeting Device with Screw (PS-1000.01), Threaded Guide Pins ×3 (PS-1000.32)</td></tr>
    <tr><th>Distal Targeting</th><td>Distal Targeting Device with Screw (PS-1000.02), Distal Guide Bar ×2 (PS-1000.03, 29), Distal Guide Bar Connector (PS-1000.28), Targeting Bar (PS-1000.07), Sliding Mass (PS-1000.08), Distal Targeting Device (PS-1000.06)</td></tr>
    <tr><th>Drill Bits</th><td>T-Type 5.84mm (PS-1000.39), 5mm ×2 (PS-1000.45), 6mm (PS-1000.44), General (PS-1000.43), Step Drill & Stop (PS-1000.34)</td></tr>
    <tr><th>Screwdrivers / Wrenches</th><td>Hex 3.5mm (PS-1000.18), Hex 4.0mm (PS-1000.19), Hex 5.0mm (PS-1000.20), T-Wrench (PS-1000.17), Locking Nut Wrench (PS-1000.21), Polyaxial Hex Wrench (PS-1000.24), L-Key 5mm (PS-1000.27)</td></tr>
    <tr><th>Insertion Tools</th><td>Nail Handle (PS-1000.04), Connection Screws ×2 (PS-1000.05), Fixture Block (PS-1000.14), Sliding Hammer (PS-1000.15), Hammer (PS-1000.10), Alignment Rod (PS-1000.36)</td></tr>
    <tr><th>Locking Components</th><td>Locking Nut Long (PS-1000.30), Locking Nut Short ×2 (PS-1000.31)</td></tr>
    <tr><th>Other Instruments</th><td>Depth Gauge (PS-1000.40), Quick Coupling T-Handle with Chuck & Key (PS-1000.25), Nail Extractor (PS-1000.35), Cleaning Guide Pins ×2 (PS-1000.22, 42), Soft Tissue Separator Short (PS-1000.16), Soft Tissue Protector (PS-1000.26), Sleeves/Trocars (PS-1000.11–13, 37–38, 46–48)</td></tr>
    <tr><th>Container</th><td>Empty Container (PS-1000.090)</td></tr>
    <tr><th>Certifications</th><td>CE Mark, ISO 13485, FDA</td></tr>
    <tr><th>Warranty</th><td>1 Year</td></tr>
    <tr><th>MOQ</th><td>1 Set</td></tr>
    <tr><th>OEM / Custom Orders</th><td>Available</td></tr>
    <tr><th>After-Sale Service</th><td>Return and Replacement</td></tr>
  </tbody>
</table>

<h2>Frequently Asked Questions</h2>

<p><strong>What fractures is the Gamma nail used for?</strong><br>
The Gamma nail is used for cephalomedullary intramedullary fixation of trochanteric, intertrochanteric, and subtrochanteric femoral fractures. Primary indications include stable and unstable intertrochanteric femoral fractures (AO/OTA 31A1, 31A2, and 31A3), where the Gamma nail's cephalomedullary design provides simultaneous intramedullary femoral shaft fixation and femoral head-neck lag screw fixation in a single construct. Subtrochanteric femoral fractures (AO/OTA 32) are also a key indication, where the biomechanical advantages of the intramedullary nail — shorter lever arm from the hip joint to the implant, reduced bending moment — are particularly important in the high-stress subtrochanteric zone. The trochanteric entry approach of the Gamma nail makes the entry portal faster and less invasive than piriformis fossa entry nails, which is advantageous in the elderly osteoporotic patients who comprise the majority of the hip fracture population and who benefit from shorter operative times.</p>

<p><strong>How does the Gamma nail differ from the PFNA-II (PS-078) and the Hip Fracture Nail (PS-091) also available from Peak Surgicals?</strong><br>
All three are cephalomedullary nails for trochanteric femoral fractures, but they differ in their proximal femoral head fixation design. The PFNA-II (PS-078, $1,628.62) uses a helical blade impacted into the femoral head without rotation — it requires a 17mm cannulated drill and a blade impactor, and is specifically designed for osteoporotic bone where blade impaction provides better purchase than a threaded screw. The Hip Fracture Nail (PS-091, $1,648.90) uses a lag screw with a separate anti-rotation bar — a two-element proximal fixation design. The Gamma nail (PS-OP-708, PS-1000 series, $1,376.06) uses a single large-diameter threaded lag screw without a separate blade or anti-rotation bar, relying on the large screw diameter and the precision of its single-element trajectory for rotation control. The choice between the three designs depends on the surgeon's preferred system and the specific nail implant design in use at the institution — each instrument set is specific to its matching nail implant and is not interchangeable between nail designs.</p>

<p><strong>What is the role of the Proximal Targeting Device with Screw and the Distal Targeting System?</strong><br>
The Proximal Targeting Device with Screw (PS-1000.01) connects to the Nail Handle and provides the fixed mechanical reference for the proximal lag screw guide wire trajectory — it directs the Threaded Guide Pins through the nail's proximal lag screw hole at the correct neck-shaft angle (130° or 125° depending on the nail model) into the femoral head. This ensures the guide pin exits in the correct position in the femoral head for the lag screw. The Distal Targeting System (comprising the Distal Targeting Device, Distal Guide Bar ×2, Distal Guide Bar Connector, Targeting Bar, and Sliding Mass) is the mechanical arm that connects to the Nail Handle and extends distally along the femoral shaft to the level of the distal nail locking holes. The Sliding Mass for Targeting Bar adjusts the position of the targeting arm along the bar to align the drill guides with the specific nail length's distal locking hole positions. Together, these two targeting systems allow the surgeon to place both the proximal lag screw and the distal locking screws mechanically guided without freehand fluoroscopic drilling — the primary safety advantage of mechanically guided targeting over freehand distal locking.</p>

<p><strong>What is the Reamer 17mm (PS-1000.23) and why is it needed in addition to the Ø9–13mm reamer shafts?</strong><br>
The Gamma nail has a proximal flare — the proximal end of the nail is wider (typically 15–17mm) than the diaphyseal portion (typically 9–12mm) to fit the wider trochanteric cancellous bone at the entry level. The five Reamer Shafts with Fixed Reamers (Ø9–13mm) progressively ream the femoral diaphysis from the entry portal to the isthmus level, establishing the correct channel for the diaphyseal portion of the nail. The Reamer 17mm (PS-1000.23) separately reams the proximal trochanteric cancellous bone at the entry level to the 17mm diameter needed to accommodate the nail's wider proximal flare — without this proximal reaming step, the nail's flared proximal end would impact the trochanteric cortex as it is advanced into the canal, risking cortical fracture or nail advancement block. The Reamer 17mm is advanced only to the depth of the trochanteric cancellous zone and does not extend to the diaphysis, while the Ø9–13mm reamers extend the full canal length from the entry to the distal isthmus.</p>

<p><strong>What certifications does this set carry?</strong><br>
The Instruments Set for Gamma Nails is manufactured under CE Mark, ISO 13485, and FDA compliant quality standards. ISO 13485 certification confirms Peak Surgicals operates a documented quality management system covering design control, material traceability, and manufacturing consistency for orthopedic surgical instruments. CE Mark confirms conformity with European medical device regulations, and FDA compliance supports procurement for US hospitals, trauma centers, and orthopedic departments requiring verified regulatory documentation for Gamma nail instrumentation purchases.</p>